Med School Hell – MSH Specialty Selection: Pediatrics

We’re going to kick of the MSH Specialty Selection Series with a look into Pediatrics. Since I haven’t really given you the lowdown on the specialty selection series, here’s a little introduction.

I want to look at specialties with regards to average salaries, hours worked weekly, overall lifestyle factors, physician satisfaction, and residency training requirements. I’ll be using survey information that can be freely found on the net as well as my personal experiences while rotating through these specialties and contact with my friends who are now residents. I personally know someone from most of the major specialties. If I have any questions, I’ll be sure to ask them so that I can give you guys a thorough review of the specialty. Unfortunately, some of the salary information is slightly dated, but it will still give you an idea of what to expect.

I’m going to cover all of the popular specialties, but probably won’t get too much into fellowships, as these are far down the road from where most of you guys are anyway. If you’d like to request a specialty review, please comment in this post and let me know.

Now, let’s get a closer look into Pediatrics.

Introduction

Pediatrics appeals to a wide variety of students, particularly because it’s simply primary care for kids. I don’t know how many times I’ve heard the phrase “I like working with kids, but not so much adults.” Although I’m not fond enough of kids to work with them on a daily basis for the rest of my life, I will say that I’d rather work with them than adults.

This is a double-edged sword, however. In order to work with kids, you’re going to have work with adults – namely the patient’s parents. Know-it-all soccer moms who spend way too much time researching things on the net can be a royal pain in the ass.

Residency Training Information

Post-graduate residency training in pediatrics is 3 years for general practice. The average starting salary for first year residents is on-par with other specialties, hovering in the high $30,000 per year range.

You can expect to work pretty damn close to the maximum 80 hours per week during your residency in pediatrics. This is especially true while on any inpatient rotation. Since inpatient medicine will make up a large proportion of your residency years, expect to be working a fair amount. While on outpatient rotations, however, you’ll probably be working something a bit more in line with reasonable work hours.

Pediatric Trends

As expected, there is an increasing number of female residents that choose to enter pediatrics. This was certainly the trend that I saw from my class, and it is something that was seen nationwide from 1997-2002. The percentage of female residents increased to a high of 69% in 2002. There are fewer International Medical Graduates entering the specialty, probably due to increased overall competitiveness and the demand for U.S. graduates in general.

Educational debt increased for residents from $64,070 in 1997 to $87,539 in 2002 while starting salaries for physicians just out of residency has been slightly decreasing.

Post Residency Careers

Across the board, pediatrics has seen a decrease in the number of residents who choose to enter general pediatrics. It’s no wonder, since primary care is probably one of the poorest choices of specialties in my opinion. On a related note, the number of available positions for general practitioners has also decreased. Instead, residents chose to pursue a fellowship and receive niche training as well as higher salaries. Fewer residents also chose to stay away from rural areas. Rural practice typically means longer work hours. The pay does sometimes scale, but people are finally beginning to realize the value of their free time.

Salaries

Surprisingly, starting salaries actually decreased from 1997 to 2002, finishing up at $99,123. I’ve always known that pediatrics was one of the lower-paying specialties of medicine, but I was actually shocked to learn that salaries have decreased instead of remaining closer to inflation that was seen over the same time period. I haven’t been able to find any salary information that’s closer to 2006-2007, but it’s the trend that you guys need to be aware of. Keep in mind that trends such as these typically do not correct overnight, and may continue for 10 years or more before any changes can be seen.

Based on this 1998 salary survey, we see a low of $111,113 with average salaries of $143,754. As you can see, there are some significant differences in data. Take what you read here with a grain of salt and remember to watch the trend.

A significant increase in salaries was seen for hospitalists, while the number of residents who took hospitalist positions decreased slightly from 1997-2002. This is important to note as I believe hospitalist employment is the next wave. Think about it – you get set shifts with a decent salary. Once your shift ends, somebody else picks up where you left off and you leave work at work. Hospitalist employment is part of what I like to refer to as “Medicine 2.0.” Expect to see more of this in the future.

Lifestyle

Overall lifestyle for practicing pediatricians after residency is average. Especially if you’re doing outpatient medicine, you’ll pretty much practice around clinic hours. Don’t expect a normal 9-5, however. After the clinic shuts down you’ll be busy for another hour or two getting your paperwork finished up. If you decide to see your clinic patients if and when they’re admitted to the hospital, expect to work an additional one to two hours in the morning rounding on those patients. This is pretty standard for all primary care outpatient practices.

One thing that I have noticed while working with pediatricians on my student rotations is that they seem happier than most docs. I also experienced this with residents. I don’t know if it’s working with kids or that they just like what they’re doing, but pediatric residents are typically a less hardcore breed as compared to medicine or surgery physicians and residents. This no doubt correlates with a better lifestyle in general, if nothing more than better overall mental and physical health.

Most of the residents that I spoke with made time to exercise and spend time with the family. This is despite a rigorous work week while on inpatient rotations.

MSH Final Thoughts

Pediatrics is one of the lower-paying specialties, particularly if you want to stay in general practice. The lifestyle after residency is appealing, but the trade off will be a decreased salary as compared to other fields.

Working with kids has its benefits (such as healthier patients, not having to deal with drug overdose or homeless patients), but always remember that you’ll be working with the parents as much as the patient. Also, hearing crying kids all day may burn you out faster than you expect. If you absolutely love kids, then you were probably born to be a pediatrician. If not, you may want to look elsewhere.

The hospitalist’s role in caring for patients is increasing and will probably get more popular as more and more people realize that it offers a much better lifestyle with increased pay in most cases. Along the same lines, I think there will be plenty of opportunities for hospitalists as general practitioners opt out of seeing clinic patients that are admitted to the hospital.

At the end of each review, I’m going to break it down into two factors: Lifestyle and Salary. The idea is to find the best combination of these two factors. In my opinion, that is the perfect specialty.

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This article is part of Hoover’s Med School Hell series. Med School Hell reveals the crazy truth about the crappiness of the US medical education and healthcare system … while making you laugh so hard, you’ll crap in your pants.